• The Journal of Korean Academy of Prosthodontics
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• v.40 no.3
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• pp.246-261
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• 2002

The screw loosening is one of the complications that happen frequently in dental implant prostheses. The purpose of this study was to evaluate the changes of reverse/loosening (opening) torque of the screw according to the surface modifications by sandblasting and 24K gold electroplating as well as to determine the possibility of the clinical use of a washer in dental implant. The reverse torque of 4 experimental conditions(control, sandblasted, use of washers, electroplasted) was measured by digital torque gauge (Model MGT50Z, Mark-10 Corp., 458 West John Street Hicksville, NY 11801 USA). Electronic torque controller (Nobel Biocare DEA 020) was used in fastening the gold screws into abutment replicas. Mixed Linear Model Analysis method was used for statistical analysis. To examine the changes of screw thread surface, microphotographs were taken by Olympus PME-3 metallurgic microscope (Olympus Optical Co. Ltd., Tokyo, Japan). Within the limitations of this study, the following results were drawn: 1. The surface modifications of the gold screws and the use of a washer have significantly affected the reverse torque value compared to the control group (P<0.01). 2. Sandblasting and electroplating treatments demonstrated significantly higher reverse torque value than that of control group. 3. The use of a washer may be one of the useful clinical methods that prevent the screw loosening. However, further studies are necessary for the material selection and design of the washer.

• Journal of Dental Rehabilitation and Applied Science
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• v.19 no.2
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• pp.125-137
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• 2003

The use of screw-retaind prosthesis on an osseointegrated implant is a popular treatment modality offering relative ease in the removal of the restoration. One of the complications associated with this modality is the loosening of the abutment and coping screws. Loosening of the screws results in patient dissatisfaction, frustration to the dentist and, if left untreated, component fracture. There are several factors which contribute to the loosening of implant components which can be controlled by the restorative dentist and lab technician. This article offers pratical solutions to minimize this clinical problem and describes the factors involved in maintaining a stable screw joint assembly. To avoid joint failure, adherence to specific clinical, as well as mechanical, parameters is critical. With respect to hardware, optimal tolerance and fit, minimal rotational play, best physical properties, a predictable interface, and optimal torque application are mandatory. In the clinical arena, optimal implant distribution; load in line with implant axis; optimal number, diameter, and length of implants; elimination of cantilevers; optimal prosthesis fit; and occlusal load control are equally important.

• Journal of Korean Neurosurgical Society
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• v.61 no.4
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• pp.494-502
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• 2018

Objective : The loosening of pedicle screws (PS) is one of the frequent problems of spinal surgery in the patients with osteoporosis. Previous studies had revealed that intermittent injection of teriparatide could reduce PS loosening by improving bone mass and quality when their patients took parathyroid hormone for a considerable duration before surgery. However, although the teriparatide is usually used after spine surgery in most clinical situations, there was no report on the efficacy of teriparatide treatment started after spine surgery. The purpose of this retrospective study was to examine the efficacy of teriparatide treatment started immediately after lumbar spinal surgery to prevent pedicle screw loosening in patients with osteoporosis. Methods : We included 84 patients with osteoporosis and degenerative lumbar disease who underwent transforaminal interbody fusion and PS fixation and received parathyroid hormone or bisphosphonate (BP) postoperatively. They were divided into teriparatide group (daily injection of $20{\mu}g$ of teriparatide for 6 months, 33 patients, 172 screws) and BP group (weekly oral administration of 35 mg of risedronate, 51 patients, 262 screws). Both groups received calcium (500 mg/day) and cholecalciferol (1000 IU/day) together. The screw loosening was evaluated with simple radiographic exams at 6 and 12 months after the surgery. We counted the number of patients with PS loosening and the number of loosened PS, and compared them between the two groups. Clinical outcomes were evaluated using visual analog scale (VAS) and Oswestry disability index (ODI) preoperatively, and at 12 months after surgery. Results : There was no significant difference in the age, sex, diabetes, smoking, bone mineral density, body mass index, and the number of fusion levels between the two groups. The number of PS loosening within 6 months after surgery did not show a significant difference between the teriparatide group (6.9%, 12/172) and the BP group (6.8%, 18/272). However, during 6-12 months after surgery, it was significantly lower in the teriparatide group (2.3%, 4/172) than the BP group (9.2%, 24/272) (p<0.05). There was no significant difference in the number of patients showing PS loosening between the teriparatide and BP groups. The teriparatide group showed a significantly higher degree of improvement of the bone mineral density (T-score) than that of BP group (p<0.05). There was no significant difference in the pre- and post-operative VAS and ODI between the groups. Conclusion : Our data suggest that the teriparatide treatment starting immediately after lumbar spinal fusion surgery could reduce PS loosening compared to BP.

• Proceedings of the KSME Conference
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• 2005.11a
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• pp.173.2-173.2
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• 2005

• Journal of Dental Rehabilitation and Applied Science
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• v.33 no.2
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• pp.114-118
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• 2017

Purpose: The aim of this study was to investigate the effects of a titanium component for the zirconia abutment in the internal connection implant system on screw loosening under thermocycling conditions. Materials and Methods: Internal connection titanium abutments and external connection zirconia abutments with titanium sockets were connected respectively to screw-shaped internal connection type titanium implants with 30 Ncm tightening. These implant-screw-abutment assemblies were divided into two groups of five specimens each; titanium abutments as control and zirconia abutments with titanium sockets as experimental group. The specimens were subjected to 2,000 thermocycles in water baths at $5^{\circ}C$ and $55^{\circ}C$, with 60 seconds of immersion at each temperature. The removal torque values (RTVs) of the abutment screws of the specimen were measured before and after thermocycling. RTVs pre- and post-thermocycling were investigated in statistics. Results: There was not screw loosening identified by tactile and visual inspection in any of the specimens during or after thermocycling. The mean RTV difference for the control group and the experimental group were $-1.34{\pm}2.53Ncm$ and $-1.26{\pm}2.06Ncm$, respectively. Statistical analysis using an independent t-test revealed that no significant differences were found in the mean RTV difference of the groups (P > 0.05). Conclusion: Within the limitations of this in vitro study, the titanium socket for the zirconia abutment did not show a significant effect on screw loosening under thermal stress compared to the titanium abutment in the internal connection implant.

• The Journal of Korean Academy of Prosthodontics
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• v.44 no.6
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• pp.740-750
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• 2006

Statement of problems. In an attempt to reduce screw loosening, dry lubricant coatings such as pure gold or tefron have been applied to the abutment screw. However, under repeated tightening and loosening procedures, low wear resistance and adhesion strength of coating material produced free particles on the surface of abutment screw and increased frictional resistance resulting in screw tightening problems. Purpose. The aim of this study was to compare friction coefficient, adhesion strength, vickers hardness and evaluate coating surface of titanium alloy specimens coated with TiN(titanium nitride), ZrN(zirconium nitride) and WC(tungsten carbide). Material and method. Titanium alloy(Ti-6Al-4V) discs of 12mm in diameter and 1mm in thickness divided into 4 groups. TiN, ZrN and WC was coated for the specimens of 3 groups respectively, and those of 1 group were not coated. Each group was made up of 4 specimens. In this study, sputtering method was used among the PVD(Physical Vapor Deposition) techniques available for TiN, ZrN and WC coatings. Friction coefficient, adhesion strength, vickers hardness and coating surface of 4 groups were measured. Results. 1. For all three coating conditions, friction coefficient was significantly decreased. Especially, ZrN coated surface showed the lowest value. $TiN(0.39{\pm}0.02)$, $ZrN(0.24{\pm}0.01)$, $WC(0.31{\pm}0.03)$. 2. TiN coating showed the highest adhesion strength, however ZrN coating had the lowest value. $TiN(25.3N{\pm}1.6)$, $ZrN(14.8N{\pm}0.6)$, $ WC(18.4N{\pm}0.7)$. 3. Vickers hardness of all three coatings was remarkably increased as compared with that of none coated specimen. TiN coating had the highest Vickers hardness, however WC coating showed the lowest value. $TiN(1865.2{\pm}33.8)$, $ZrN(1814.4{\pm}18.6)$, $WC(1008.5{\pm}35.9)$. 4. The ZrN or WC coated specimen showed a homogeneous and smooth surface, however the rough surface with defects was observed for TiN coating. Conclusions. When TiN, ZrN and WC coating applied to the abutment screw, frictional resistance would be reduced, as a result, the greater preload and prevention of the screw loosening could be expected.

• The Journal of Korean Academy of Prosthodontics
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• v.45 no.1
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• pp.119-130
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• 2007

Statement of problem: A few dry lubricants were applied to abutment screws for the improvement of joint stability. Purpose: The purpose of this study was to evaluate the surface change and fit of TiN-Coated abutment screw through the examination of tested screws in the field emission scanning electron microscope(FE-SEM;Netherland, Phillips co., model:XL 30 SFEG) after repeated closing and opening. Materials and method: Titanium(3i/implant Innovations Inc, USA) and Gold-Tite abutment screws(3i/implant Innovations Inc, USA) were selected for Group A and C respectively. TiN coated titanium abutment screws were also divided into two groups, Group B and D. Abutment screws of each group and the fit of abutment screw/implant fixture/abutment were observed on FE-SEM after repeated closing and opening test respectively. Results: 1. The abutment screws of TiN coated groups(Group B and D) showed more remarkable wear resistance in the threads of the screw than those of the other group(Group A and C). 2. There were more severe wear and defect of TiN coating in Group D tightened to 32 Ncm than Group B to 20 Ncm. 3. There was no difference in the fit of abutment screw/fixture/abutment among four groups, Group A, Group B, Group C and Group D. Conclusion: Under the conditions of this study, it is suggested that TiN coating of abutment screw be clinically acceptable and be expected to reduce the risk of abutment screw loosening. TiN coating of abutment screw showed good resistance against wear and the adequate fit of abutment screw/implant fixture/abutment.

• The Journal of Korean Academy of Prosthodontics
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• v.46 no.2
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• pp.137-147
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• 2008

Statement of problem: Dental implant procedure has been recognized as a very effective treatment to rehabilitate fully or partially edentulous patients. However, mechanical failures such as screw loosening, screw fracture have been still reported frequently. Purpose: The purpose of this study was to evaluate the influence of tungsten carbide/carbon coating, which has superior hardness and frictional wear resistance, on implant-abutment screw loosening of three different joint connections after one million cyclic loading. Material and methods: The values of detorque before and after loading were measured in three different joint connections (Osstem Implant, Korea), one external butt joint, US II implant system and two internal cones, SS II and GS II system. The values of detorque before loading was analyzed by one-way ANOVA, and two-way ANOVA and Scheffe' test were performed for the value of detorque after loading. Results: 1. The values of initial detorque of tungsten carbide/carbon coated Ti alloy screw were smaller those of Ti alloy screw (P<.01), and there were no differences among implant systems in each screw (P>.05). 2. In comparison of loss rate of detorque value after cyclic loading, US II system was greater than SS II and GS II system but there was no difference between SS II and GS II system (P<.01). 3. Loss rates of detorque value after cyclic loading decreased consistently at tungsten carbide/carbon coated Ti alloy screw comparing with Ti alloy screw in all implant systems (P<.01), and there were no differences among three systems in reduction of loss rates by using tungsten carbide/carbon coated Ti alloy screw (P>.05). Conclusion: Tungsten carbide/carbon coating to increase preload with reduction of friction resistance was a effective way to decrease screw loosening by functional loading.

• The Journal of Korean Academy of Prosthodontics
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• v.55 no.3
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• pp.251-257
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• 2017

Purpose: The purpose of this study was to evaluate whether the internal abutment length affected screw stability in an internal connection implant. Materials and methods: Twenty long internal connection implants (Replus system, $4.7{\times}11.5mm$) were selected for this investigation. Abutments were assigned to four groups depending on the length of the internal connection (abutments with internal lengths of 1, 2, 3, and 4 mm, respectively). Each implant fixture specimen was embedded in resin medium and connected to an abutment with an abutment screw. A load of 100 N, applied at an angle of $30^{\circ}$ to the long axis of the implant, was repeated for $1.0{\times}10^6$ cycles. Reverse torque values (RTV) were recorded before and after loading, and the change in RTV was calculated. Data were analyzed with the Kruskal-Wallis test. Results: The change in RTV was not significantly different among the groups (P>.05). Screw loosening and fractures were not observed in any groups, and joint stability was maintained. Conclusion: The internal length of the abutment may not significantly affect the degree of screw loosening.

• 대한치과보철학회:학술대회논문집
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• 1999.11a
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• pp.51-51
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• 1999